Xaysanasy, Phetsamone Peter
Xaysanasy, Phetsamone Peter is an individual health care provider with primary practice located at 125 W Sunbridge Dr Suite 1, Fayetteville AR 72703-1899. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Xaysanasy, Phetsamone Peter can be contacted via phone (479) 251-9200.Contact Information
Primary practice address
125 W Sunbridge Dr Suite 1
Fayetteville AR 72703-1899
Phone: (479) 251-9200
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 193 | Arkansas |
Profile Details
| NPI number | 1063456184 |
|---|---|
| LBN Legal business name | Xaysanasy, Phetsamone Peter |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2006 |
| Last updated | Jan 3rd, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063456184 | NPPES |
| Arkansas | MEDICAID | 14086717 |
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